Readability of Hospital Patient Financial Policy Documents

There are federal and state policies designed to enhance access to information about financial assistance and billing policies at hospitals, particularly nonprofit ones. This information is increasingly important as patients' out-of-pocket costs and medical debt rise, and those with low literacy may struggle in particular. This study assesses the availability and readability of hospital financial assistance and payment policy documents.

Cross-sectional study of online patient financial policy documents collected from a random 10% (N = 336) sample of general nongovernmental hospitals in the US, March to June 2025.

The Flesch-Kincaid Grade Level for readability was calculated for each financial assistance and payment policy document. Hospital characteristics associated with documents' availability and readability were analyzed using multivariate regression models.

The mean readability level of each policy document type was at least 10th grade. Nonprofit and system-affiliated hospitals were significantly more likely to provide patient financial policy documents in models adjusting for other hospital characteristics. Hospitals in states with expanded financial assistance requirements had more readable financial assistance policy documents than other hospitals. Teaching hospitals and hospitals receiving Disproportionate Share Hospital (DSH) payments had more readable billing and collections policies than their counterparts.

These findings suggest that existing federal requirements for nonprofit hospitals correspond with greater availability of patient financial policy documents. Additionally, state policy environments, system affiliation, and DSH status correspond with better readability. Yet considering that a slim majority of Americans read below a 6th-grade level, the mean readability at the 10th-grade level for "plain language" policy documents may challenge some patients.